Le Trouble de Stress Post-traumatique parmi les Détenus en Centre

Le Trouble de Stress Post-traumatique parmi les
D´etenus en Centre P´enitentiaire en Guyane Fran¸caise
Romain Arnal, G¨ulen Ayhan, ´ Eric Pinganaud, C´elia Basurko, Louis Jehel
To cite this version:
Romain Arnal, G¨ulen Ayhan, ´ Eric Pinganaud, C´elia Basurko, Louis Jehel. Le Trouble de
Stress Post-traumatique parmi les D´etenus en Centre P´enitentiaire en Guyane Fran¸caise. Sant´e
mentale au Qu´ebec, 2016, 41 (1), pp.251-65.
HAL Id: inserm-01421075
http://www.hal.inserm.fr/inserm-01421075
Submitted on 21 Dec 2016
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Draft
Le Trouble de Stress Post
-
traumatique parmi les Détenus en
Centre Pénitentiaire en Guyane Française
Journal: Santé Mentale au Québec
Manuscript ID smq-2015-0073.R1
Manuscript Type: Article
Keyword: French Guiana, Forensic Psychiatry, PTSD, Comorbidity
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Le Trouble de Stress Post-traumatique parmi
les Détenus en Centre
Pénitentiaire en Guyane França i se
Mémoire Or i g i na l
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Résumé
Soumis à des mouvements de population importants, la Guyane Française et son centre pénitentiaire abritent
une population métissée chez qui l’histoire récente a laissé une empreinte forte (tremblement de terre en Haïti,
guerre civile au Suriname, violence liée à l’orpaillage et au trafic de stupéfiants). Ces événements de vie
négatifs apparaissent comme autant de vecteurs potentiels de psychotraumatismes. Dans ces conditions, il nous
a paru essentiel de mettre l’accent sur le repérage du TSPT (Trouble de Stress Post-traumatique ) dans cette
population sensible. A l'aide d’entretiens d’accueil dédiés nous nous sommes proposé de repérer les TSPT, de
décrire sur un plan sociodémographique la population étudiée et de rechercher les comorbidités psychiatriques.
Le résultat principal de cette étude était une prévalence du TSPT de 17% chez les arrivants en détention. Le
MINI 5.0 a montré une prévalence plus élevée des pathologies psychiatriques dans le groupe présentant un
TSPT avec un lien très fort (p<0.005) pour l’épisode dépressif majeur actuel, l’épisode (hypo)maniaque actuel
et le risque suicidaire. Cette étude appuie la nécessité d’avoir un dépistage systématique du TSPT chez les
arrivants en détention. Cette pathologie est à la fois fréquente dans cette population et invalidante mais ce sont
ses comorbidités, dont le potentiel suicidaire, qui font tout l’enjeu d’un repérage précoce.
Mots-clés
Guyane française, psychiatrie carcérale, TSPT, comorbidités
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Post-traumatic stress disorder among incomers in
Rémire Montjoly prison, French Guiana
MeSH: French Guiana, Forensic Psychiatry, PTSD, Comorbidity
Abstract: Despite the recent interest in psychiatric illness in prison, the psychopathology of the Rémire
Montjoly prison population remains largely unknown. Subject to significant population movements, French
Guiana and its prison houses a very mixed population in which recent history has left a strong mark (earthquake
in Haiti, civil war in Suriname, violence related to gold mining population and drug trafficking). These negative
life events appear as potential vectors of Psychological Trauma. Additionally, strong links have been established
in the literature between posttraumatic stress and many other psychiatric disorders, including suicidal behavior
and addictions. Under these conditions, we felt it essential to focus on the identification of posttraumatic stress
in this sensitive population.
Through adapted reception interviews we tried to identify the posttraumatic stress disorders, to describe by
means of socio-demographic factors the studied population and to detect psychiatric comorbidities. The
screening tool was the MINI 5.0, which identifies 17 psychiatric disorders including the posttraumatic stress,
based on the DSM IV definition. The target population was the prison incomers, agreeing to participate in the
study, aged more than 18 years old and imprisoned between 18 January 2013 and 31 December 2013. To this
date, 549 inmates were included in the study.
The main result of this study was a prevalence of posttraumatic stress disorder of 17 % for incomers in
detention. We found that the PTSD+ population is more likely to be female (15% against 7% p = 0.0246),
which is consistent with the literature data. The MINI 5.0 showed a higher prevalence of psychiatric disorders
in the PTSD+ group. This association was confirmed in several types of pathology like mood disorders
including: major depressive episode and (hypo-)manic episode, suicidal risk, some anxiety disorders including:
panic disorder, obsessive compulsive disorder and generalized anxiety disorder. Strong association was found
for current major depressive episode, current (hypo)manic episode and suicidal risk (p < 0.005).
The prevalence of posttraumatic stress disorder is very high in this study, about 24 times higher than in a
general population survey using the same screening tool.
A large number of comorbidities have been identified, which corresponds to those described in
the literature. The specific issues of psychiatry in prison lead us to examine more specifically the significance
of the results about suicide risk. A comprehensive suicide risk (sum of medium and high risk screened by the
MINI) was found in significantly more PTSD+ inmates (17% versus 7%, p = 0.005). This study supports the
need for routine screening of posttraumatic stress disorder among incomers in detention. This disease is both
worrying and common in this population but the real issues are the comorbidities. Suicidal potential is among
the most important issues in detention. Its evaluation should be completed by an early recognition of a post-
traumatic stress disorder.
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